Pre-Labour Rupture of Membranes after 37 Weeks of Pregnancy

If your waters break before labour starts

In around 8-10% pregnancies the waters surrounding baby can break before labour starts. If your waters break before your labour starts, it is helpful to note the time and colour of the waters. We would also recommend that you put on a maternity pad and call Maternity Triage (24-hour number) on 02476 865246.

What will happen next?

After speaking to the Triage Midwife, you may be invited into hospital to confirm your waters have broken. When at Maternity Triage, the Midwife will gain your consent to:

• Check your blood pressure, pulse and temperature as well as a urine sample.
• Check your maternity pad to monitor the amount and colour of fluid you are losing.
• Listen to your baby’s heartbeat. A Cardiotocograph (CTG) may be performed to check on your baby’s wellbeing. This will be dependent on your risk factors.
• A speculum examination will be offered to you. During this, a test can be carried out which can confirm that your waters have broken. A vaginal examination will only be offered if you are regularly contracting to help reduce the risk of infection.

If prelabour rupture of membranes is not confirmed, and there are no other concerns you will be discharged home and advised to call if you have further vaginal loss or concerns. If rupture of membranes is confirmed the information below describes the care you will be offered in line with National guidance.

Induction of labour

NICE report 60% of women with prelabour rupture of membranes will go into labour within 24 hours, therefore you may be discharged home to allow labour to establish. If you do not go into labour within 24 hours, in line with national guidance, induction of labour will be offered to you. In the event of any other concerns, you have been confirmed to have a positive Group B Streptococcus (GBS) sample or a previous child affected by GBS, induction of labour will be offered immediately.

The Induction of labour process involves 3 different methods. The midwife caring for you will also talk this through with you, to allow you to make a fully informed choice about your care. They will also be able to answer any questions you may have. These include:

1. A Prostaglandin gel being placed behind the cervix. This will allow the cervix to soften and dilate.  A maximum of two gels may be given.
2. If there is a pocket of waters in front of the baby’s head, these may be broken to start labour. If this is not possible the doctor will discuss the potential need for delivery by caesarean section.
3. An oxytocin drip may be offered if contractions are not regular.

If it is more than 24 hours since your waters broke, continuous monitoring of the baby’s heartbeat is recommended. Once your waters are ready to be broken or awaiting an oxytocin drip, this will be performed on Labour Suite. There may be a delay to ensure 1:1 care can be achieved; however, this will be considered as a matter of urgency.

Why is an induction of labour offered?

NICE highlight the risk of serious infection for baby increases from 1:200 to 1:100 once membranes break. The longer the time between waters breaking and baby being born, this risk increases. If left untreated, your baby may also develop an infection which can lead to admission to the Special Care Baby Unit (SCBU). It's important to note that the possible effects of prolonged rupture of membranes can vary depending on the specific circumstances. As your healthcare providers, we closely monitor pregnancies with prolonged rupture of membranes and may suggest intervention to help reduce potential risks and complications.

These risks include:

• Prolonged rupture of membranes increases the risk of infection for both the mother and the baby. Without the protective barrier of the amniotic sac, bacteria can ascend into the uterus, potentially leading to intrauterine infection (chorioamnionitis). This infection can then be transmitted to the newborn during delivery. If left untreated, this can lead to life threatening sepsis for both mum and baby.
• Prolonged exposure to ruptured amniotic fluid can lead to respiratory distress syndrome (RDS). In some cases, infants born after prolonged rupture of membranes may be at an increased risk of respiratory distress syndrome, a condition characterised by difficulty breathing due to immature lungs.

If you have an uncomplicated vaginal birth, we recommend at least 12 hours of monitoring of your baby for infection after birth, this will usually happen whilst your baby remains with you. There is still a risk of infection for you and baby for up to 5 days post birth.  Please contact the Triage number if you have any concerns at home.

Whilst at home, you must call the 24-hour number immediately if any of the below occur.

• You should check your temperature every 4 hours, If you have a temperature over 37.4 degrees, call immediately. Tempa dots (disposable thermometers) can be given if you do not have a thermometer.
• If your waters are no longer draining clear, are green or fresh red in colour.
• If your waters have an offensive smell.
• You have flu-like symptoms or are feverish.
• You have fresh red bleeding.
• Baby’s movements change or are reduced.
• You are having regular contractions or have constant abdominal pain or tenderness.

It is safe to bath or shower following prelabour rupture of membranes. However, we do not advise intercourse due to the increased risk of infection.

Any queries or concerns, please contact Maternity Triage on 02476 865246 at any time.

Temperature Monitoring Chart
Please contact Maternity Triage (02476 865246) if your temperature is over 37.4°C.

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